Healthcare Provider Details

I. General information

NPI: 1497457428
Provider Name (Legal Business Name): KAITLYN R LATTIMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 W A ST STE B
LINCOLN NE
68522-1231
US

IV. Provider business mailing address

2330 SW 47TH ST
LINCOLN NE
68522-8762
US

V. Phone/Fax

Practice location:
  • Phone: 402-465-5600
  • Fax:
Mailing address:
  • Phone: 775-351-8154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37423
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: